|
PR AMP F/ARM THRU RADIUS&ULNA SEC CLOSURE/SCAR RE
|
Professional
|
Both
|
$1,664.00
|
|
|
Service Code
|
HCPCS 25907
|
| Min. Negotiated Rate |
$373.39 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$763.30
|
| Rate for Payer: Aetna Medicare |
$592.42
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$763.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$820.27
|
| Rate for Payer: BCBS Complete |
$392.06
|
| Rate for Payer: BCBS MAPPO |
$569.63
|
| Rate for Payer: BCN Commercial |
$943.68
|
| Rate for Payer: BCN Medicare Advantage |
$569.63
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cash Price |
$1,331.20
|
| Rate for Payer: Cofinity Commercial |
$763.30
|
| Rate for Payer: Cofinity Commercial |
$820.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$569.63
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$598.11
|
| Rate for Payer: Meridian Medicaid |
$392.06
|
| Rate for Payer: Molina Medicare/Medicaid |
$626.59
|
| Rate for Payer: Nomi Health Commercial |
$683.56
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,248.00
|
| Rate for Payer: PACE SWMI |
$569.63
|
| Rate for Payer: PHP Commercial |
$797.48
|
| Rate for Payer: PHP Medicare Advantage |
$569.63
|
| Rate for Payer: Priority Health Choice Medicaid |
$373.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,008.77
|
| Rate for Payer: Priority Health Medicare |
$569.63
|
| Rate for Payer: Priority Health SBD |
$1,008.77
|
| Rate for Payer: Priority Health Tiered Network |
$1,008.77
|
| Rate for Payer: Railroad Medicare Medicare |
$569.63
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,069.26
|
| Rate for Payer: UHC Core |
$1,069.26
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$569.63
|
| Rate for Payer: UHC Exchange |
$1,069.26
|
| Rate for Payer: UHC Medicaid |
$373.39
|
| Rate for Payer: UHCCP Medicaid |
$373.39
|
| Rate for Payer: UMR Bronson Commercial |
$765.44
|
|
|
PR AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR
|
Professional
|
Both
|
$1,978.00
|
|
|
Service Code
|
HCPCS 25905
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,483.50 |
| Rate for Payer: Aetna Commercial |
$863.11
|
| Rate for Payer: Aetna Medicare |
$669.87
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$863.11
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$927.52
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCBS MAPPO |
$644.11
|
| Rate for Payer: BCN Commercial |
$1,073.15
|
| Rate for Payer: BCN Medicare Advantage |
$644.11
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cash Price |
$1,582.40
|
| Rate for Payer: Cofinity Commercial |
$863.11
|
| Rate for Payer: Cofinity Commercial |
$927.52
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$644.11
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$676.32
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$708.52
|
| Rate for Payer: Nomi Health Commercial |
$772.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,483.50
|
| Rate for Payer: PACE SWMI |
$644.11
|
| Rate for Payer: PHP Commercial |
$901.75
|
| Rate for Payer: PHP Medicare Advantage |
$644.11
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,147.17
|
| Rate for Payer: Priority Health Medicare |
$644.11
|
| Rate for Payer: Priority Health SBD |
$1,147.17
|
| Rate for Payer: Priority Health Tiered Network |
$1,147.17
|
| Rate for Payer: Railroad Medicare Medicare |
$644.11
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,224.73
|
| Rate for Payer: UHC Core |
$1,224.73
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$644.11
|
| Rate for Payer: UHC Exchange |
$1,224.73
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
| Rate for Payer: UMR Bronson Commercial |
$909.88
|
|
|
PR AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION
|
Professional
|
Both
|
$1,274.00
|
|
|
Service Code
|
HCPCS 25909
|
| Min. Negotiated Rate |
$411.94 |
| Max. Negotiated Rate |
$1,195.97 |
| Rate for Payer: Aetna Commercial |
$844.31
|
| Rate for Payer: Aetna Medicare |
$655.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$844.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$907.32
|
| Rate for Payer: BCBS Complete |
$432.54
|
| Rate for Payer: BCBS MAPPO |
$630.08
|
| Rate for Payer: BCN Commercial |
$1,049.74
|
| Rate for Payer: BCN Medicare Advantage |
$630.08
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cash Price |
$1,019.20
|
| Rate for Payer: Cofinity Commercial |
$844.31
|
| Rate for Payer: Cofinity Commercial |
$907.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$630.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$661.58
|
| Rate for Payer: Meridian Medicaid |
$432.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$693.09
|
| Rate for Payer: Nomi Health Commercial |
$756.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$955.50
|
| Rate for Payer: PACE SWMI |
$630.08
|
| Rate for Payer: PHP Commercial |
$882.11
|
| Rate for Payer: PHP Medicare Advantage |
$630.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$411.94
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,122.14
|
| Rate for Payer: Priority Health Medicare |
$630.08
|
| Rate for Payer: Priority Health SBD |
$1,122.14
|
| Rate for Payer: Priority Health Tiered Network |
$1,122.14
|
| Rate for Payer: Railroad Medicare Medicare |
$630.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,195.97
|
| Rate for Payer: UHC Core |
$1,195.97
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$630.08
|
| Rate for Payer: UHC Exchange |
$1,195.97
|
| Rate for Payer: UHC Medicaid |
$411.94
|
| Rate for Payer: UHCCP Medicaid |
$411.94
|
| Rate for Payer: UMR Bronson Commercial |
$586.04
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP
|
Professional
|
Both
|
$2,266.00
|
|
|
Service Code
|
HCPCS 26952
|
| Min. Negotiated Rate |
$425.79 |
| Max. Negotiated Rate |
$1,699.50 |
| Rate for Payer: Aetna Commercial |
$853.35
|
| Rate for Payer: Aetna Medicare |
$662.30
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$853.35
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$917.04
|
| Rate for Payer: BCBS Complete |
$447.08
|
| Rate for Payer: BCBS MAPPO |
$636.83
|
| Rate for Payer: BCN Commercial |
$1,034.80
|
| Rate for Payer: BCN Medicare Advantage |
$636.83
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cash Price |
$1,812.80
|
| Rate for Payer: Cofinity Commercial |
$853.35
|
| Rate for Payer: Cofinity Commercial |
$917.04
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$636.83
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$668.67
|
| Rate for Payer: Meridian Medicaid |
$447.08
|
| Rate for Payer: Molina Medicare/Medicaid |
$700.51
|
| Rate for Payer: Nomi Health Commercial |
$764.20
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,699.50
|
| Rate for Payer: PACE SWMI |
$636.83
|
| Rate for Payer: PHP Commercial |
$891.56
|
| Rate for Payer: PHP Medicare Advantage |
$636.83
|
| Rate for Payer: Priority Health Choice Medicaid |
$425.79
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,106.18
|
| Rate for Payer: Priority Health Medicare |
$636.83
|
| Rate for Payer: Priority Health SBD |
$1,106.18
|
| Rate for Payer: Priority Health Tiered Network |
$1,106.18
|
| Rate for Payer: Railroad Medicare Medicare |
$636.83
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,127.29
|
| Rate for Payer: UHC Core |
$1,127.29
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$636.83
|
| Rate for Payer: UHC Exchange |
$1,127.29
|
| Rate for Payer: UHC Medicaid |
$425.79
|
| Rate for Payer: UHCCP Medicaid |
$425.79
|
| Rate for Payer: UMR Bronson Commercial |
$1,042.36
|
|
|
PR AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR
|
Professional
|
Both
|
$1,700.00
|
|
|
Service Code
|
HCPCS 26951
|
| Min. Negotiated Rate |
$446.02 |
| Max. Negotiated Rate |
$1,275.00 |
| Rate for Payer: Aetna Commercial |
$889.92
|
| Rate for Payer: Aetna Medicare |
$690.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$889.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$956.33
|
| Rate for Payer: BCBS Complete |
$468.32
|
| Rate for Payer: BCBS MAPPO |
$664.12
|
| Rate for Payer: BCN Commercial |
$1,065.18
|
| Rate for Payer: BCN Medicare Advantage |
$664.12
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cash Price |
$1,360.00
|
| Rate for Payer: Cofinity Commercial |
$889.92
|
| Rate for Payer: Cofinity Commercial |
$956.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$664.12
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$697.33
|
| Rate for Payer: Meridian Medicaid |
$468.32
|
| Rate for Payer: Molina Medicare/Medicaid |
$730.53
|
| Rate for Payer: Nomi Health Commercial |
$796.94
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,275.00
|
| Rate for Payer: PACE SWMI |
$664.12
|
| Rate for Payer: PHP Commercial |
$929.77
|
| Rate for Payer: PHP Medicare Advantage |
$664.12
|
| Rate for Payer: Priority Health Choice Medicaid |
$446.02
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,138.65
|
| Rate for Payer: Priority Health Medicare |
$664.12
|
| Rate for Payer: Priority Health SBD |
$1,138.65
|
| Rate for Payer: Priority Health Tiered Network |
$1,138.65
|
| Rate for Payer: Railroad Medicare Medicare |
$664.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,138.59
|
| Rate for Payer: UHC Core |
$1,138.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$664.12
|
| Rate for Payer: UHC Exchange |
$1,138.59
|
| Rate for Payer: UHC Medicaid |
$446.02
|
| Rate for Payer: UHCCP Medicaid |
$446.02
|
| Rate for Payer: UMR Bronson Commercial |
$782.00
|
|
|
PR AMPICILLIN 500 MG INJ
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J0290
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$15.75 |
| Rate for Payer: Aetna Commercial |
$0.86
|
| Rate for Payer: Aetna Medicare |
$0.67
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.92
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$0.86
|
| Rate for Payer: BCBS MAPPO |
$0.64
|
| Rate for Payer: BCBS Trust/PPO |
$0.11
|
| Rate for Payer: BCN Commercial |
$0.10
|
| Rate for Payer: BCN Medicare Advantage |
$0.64
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cofinity Commercial |
$0.86
|
| Rate for Payer: Cofinity Commercial |
$0.92
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$0.64
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$0.67
|
| Rate for Payer: Molina Medicare/Medicaid |
$0.70
|
| Rate for Payer: Nomi Health Commercial |
$0.77
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$15.75
|
| Rate for Payer: PACE SWMI |
$0.64
|
| Rate for Payer: PHP Commercial |
$0.90
|
| Rate for Payer: PHP Medicare Advantage |
$0.64
|
| Rate for Payer: Priority Health Medicare |
$0.64
|
| Rate for Payer: Railroad Medicare Medicare |
$0.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$0.59
|
| Rate for Payer: UHC Core |
$0.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$0.64
|
| Rate for Payer: UHC Exchange |
$0.59
|
| Rate for Payer: UMR Bronson Commercial |
$9.66
|
|
|
PR AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION
|
Professional
|
Both
|
$2,053.00
|
|
|
Service Code
|
HCPCS 27886
|
| Min. Negotiated Rate |
$383.83 |
| Max. Negotiated Rate |
$1,539.75 |
| Rate for Payer: Aetna Commercial |
$797.22
|
| Rate for Payer: Aetna Medicare |
$618.74
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$856.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$797.22
|
| Rate for Payer: BCBS Complete |
$403.02
|
| Rate for Payer: BCBS MAPPO |
$594.94
|
| Rate for Payer: BCN Commercial |
$974.05
|
| Rate for Payer: BCN Medicare Advantage |
$594.94
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cash Price |
$1,642.40
|
| Rate for Payer: Cofinity Commercial |
$856.71
|
| Rate for Payer: Cofinity Commercial |
$797.22
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$594.94
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$624.69
|
| Rate for Payer: Meridian Medicaid |
$403.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$654.43
|
| Rate for Payer: Nomi Health Commercial |
$713.93
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,539.75
|
| Rate for Payer: PACE SWMI |
$594.94
|
| Rate for Payer: PHP Commercial |
$832.92
|
| Rate for Payer: PHP Medicare Advantage |
$594.94
|
| Rate for Payer: Priority Health Choice Medicaid |
$383.83
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,041.24
|
| Rate for Payer: Priority Health Medicare |
$594.94
|
| Rate for Payer: Priority Health SBD |
$1,041.24
|
| Rate for Payer: Priority Health Tiered Network |
$1,041.24
|
| Rate for Payer: Railroad Medicare Medicare |
$594.94
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,154.59
|
| Rate for Payer: UHC Core |
$1,154.59
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$594.94
|
| Rate for Payer: UHC Exchange |
$1,154.59
|
| Rate for Payer: UHC Medicaid |
$383.83
|
| Rate for Payer: UHCCP Medicaid |
$383.83
|
| Rate for Payer: UMR Bronson Commercial |
$944.38
|
|
|
PR AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
HCPCS 27884
|
| Min. Negotiated Rate |
$349.32 |
| Max. Negotiated Rate |
$1,329.75 |
| Rate for Payer: Aetna Commercial |
$723.22
|
| Rate for Payer: Aetna Medicare |
$561.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$723.22
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$777.20
|
| Rate for Payer: BCBS Complete |
$366.79
|
| Rate for Payer: BCBS MAPPO |
$539.72
|
| Rate for Payer: BCN Commercial |
$870.97
|
| Rate for Payer: BCN Medicare Advantage |
$539.72
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Cash Price |
$1,418.40
|
| Rate for Payer: Cofinity Commercial |
$723.22
|
| Rate for Payer: Cofinity Commercial |
$777.20
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$539.72
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$566.71
|
| Rate for Payer: Meridian Medicaid |
$366.79
|
| Rate for Payer: Molina Medicare/Medicaid |
$593.69
|
| Rate for Payer: Nomi Health Commercial |
$647.66
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,329.75
|
| Rate for Payer: PACE SWMI |
$539.72
|
| Rate for Payer: PHP Commercial |
$755.61
|
| Rate for Payer: PHP Medicare Advantage |
$539.72
|
| Rate for Payer: Priority Health Choice Medicaid |
$349.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$931.04
|
| Rate for Payer: Priority Health Medicare |
$539.72
|
| Rate for Payer: Priority Health SBD |
$931.04
|
| Rate for Payer: Priority Health Tiered Network |
$931.04
|
| Rate for Payer: Railroad Medicare Medicare |
$539.72
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,009.13
|
| Rate for Payer: UHC Core |
$1,009.13
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$539.72
|
| Rate for Payer: UHC Exchange |
$1,009.13
|
| Rate for Payer: UHC Medicaid |
$349.32
|
| Rate for Payer: UHCCP Medicaid |
$349.32
|
| Rate for Payer: UMR Bronson Commercial |
$815.58
|
|
|
PR AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER
|
Professional
|
Both
|
$2,549.00
|
|
|
Service Code
|
HCPCS 26910
|
| Min. Negotiated Rate |
$472.22 |
| Max. Negotiated Rate |
$1,911.75 |
| Rate for Payer: Aetna Commercial |
$949.94
|
| Rate for Payer: Aetna Medicare |
$737.27
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,020.83
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$949.94
|
| Rate for Payer: BCBS Complete |
$495.83
|
| Rate for Payer: BCBS MAPPO |
$708.91
|
| Rate for Payer: BCN Commercial |
$1,152.83
|
| Rate for Payer: BCN Medicare Advantage |
$708.91
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cash Price |
$2,039.20
|
| Rate for Payer: Cofinity Commercial |
$1,020.83
|
| Rate for Payer: Cofinity Commercial |
$949.94
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$708.91
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$744.36
|
| Rate for Payer: Meridian Medicaid |
$495.83
|
| Rate for Payer: Molina Medicare/Medicaid |
$779.80
|
| Rate for Payer: Nomi Health Commercial |
$850.69
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,911.75
|
| Rate for Payer: PACE SWMI |
$708.91
|
| Rate for Payer: PHP Commercial |
$992.47
|
| Rate for Payer: PHP Medicare Advantage |
$708.91
|
| Rate for Payer: Priority Health Choice Medicaid |
$472.22
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,232.34
|
| Rate for Payer: Priority Health Medicare |
$708.91
|
| Rate for Payer: Priority Health SBD |
$1,232.34
|
| Rate for Payer: Priority Health Tiered Network |
$1,232.34
|
| Rate for Payer: Railroad Medicare Medicare |
$708.91
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,263.90
|
| Rate for Payer: UHC Core |
$1,263.90
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$708.91
|
| Rate for Payer: UHC Exchange |
$1,263.90
|
| Rate for Payer: UHC Medicaid |
$472.22
|
| Rate for Payer: UHCCP Medicaid |
$472.22
|
| Rate for Payer: UMR Bronson Commercial |
$1,172.54
|
|
|
PR AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION
|
Professional
|
Both
|
$1,145.00
|
|
|
Service Code
|
HCPCS 27594
|
| Min. Negotiated Rate |
$304.80 |
| Max. Negotiated Rate |
$897.21 |
| Rate for Payer: Aetna Commercial |
$628.58
|
| Rate for Payer: Aetna Medicare |
$487.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$628.58
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$675.49
|
| Rate for Payer: BCBS Complete |
$320.04
|
| Rate for Payer: BCBS MAPPO |
$469.09
|
| Rate for Payer: BCN Commercial |
$763.41
|
| Rate for Payer: BCN Medicare Advantage |
$469.09
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cash Price |
$916.00
|
| Rate for Payer: Cofinity Commercial |
$628.58
|
| Rate for Payer: Cofinity Commercial |
$675.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$469.09
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$492.54
|
| Rate for Payer: Meridian Medicaid |
$320.04
|
| Rate for Payer: Molina Medicare/Medicaid |
$516.00
|
| Rate for Payer: Nomi Health Commercial |
$562.91
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$858.75
|
| Rate for Payer: PACE SWMI |
$469.09
|
| Rate for Payer: PHP Commercial |
$656.73
|
| Rate for Payer: PHP Medicare Advantage |
$469.09
|
| Rate for Payer: Priority Health Choice Medicaid |
$304.80
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$816.06
|
| Rate for Payer: Priority Health Medicare |
$469.09
|
| Rate for Payer: Priority Health SBD |
$816.06
|
| Rate for Payer: Priority Health Tiered Network |
$816.06
|
| Rate for Payer: Railroad Medicare Medicare |
$469.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$897.21
|
| Rate for Payer: UHC Core |
$897.21
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$469.09
|
| Rate for Payer: UHC Exchange |
$897.21
|
| Rate for Payer: UHC Medicaid |
$304.80
|
| Rate for Payer: UHCCP Medicaid |
$304.80
|
| Rate for Payer: UMR Bronson Commercial |
$526.70
|
|
|
PR AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR
|
Professional
|
Both
|
$1,301.00
|
|
|
Service Code
|
HCPCS 24920
|
| Min. Negotiated Rate |
$438.14 |
| Max. Negotiated Rate |
$1,279.80 |
| Rate for Payer: Aetna Commercial |
$899.33
|
| Rate for Payer: Aetna Medicare |
$697.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$899.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$966.44
|
| Rate for Payer: BCBS Complete |
$460.05
|
| Rate for Payer: BCBS MAPPO |
$671.14
|
| Rate for Payer: BCN Commercial |
$1,120.46
|
| Rate for Payer: BCN Medicare Advantage |
$671.14
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cash Price |
$1,040.80
|
| Rate for Payer: Cofinity Commercial |
$899.33
|
| Rate for Payer: Cofinity Commercial |
$966.44
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$671.14
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$704.70
|
| Rate for Payer: Meridian Medicaid |
$460.05
|
| Rate for Payer: Molina Medicare/Medicaid |
$738.25
|
| Rate for Payer: Nomi Health Commercial |
$805.37
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$975.75
|
| Rate for Payer: PACE SWMI |
$671.14
|
| Rate for Payer: PHP Commercial |
$939.60
|
| Rate for Payer: PHP Medicare Advantage |
$671.14
|
| Rate for Payer: Priority Health Choice Medicaid |
$438.14
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,197.74
|
| Rate for Payer: Priority Health Medicare |
$671.14
|
| Rate for Payer: Priority Health SBD |
$1,197.74
|
| Rate for Payer: Priority Health Tiered Network |
$1,197.74
|
| Rate for Payer: Railroad Medicare Medicare |
$671.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,279.80
|
| Rate for Payer: UHC Core |
$1,279.80
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$671.14
|
| Rate for Payer: UHC Exchange |
$1,279.80
|
| Rate for Payer: UHC Medicaid |
$438.14
|
| Rate for Payer: UHCCP Medicaid |
$438.14
|
| Rate for Payer: UMR Bronson Commercial |
$598.46
|
|
|
PR AMPUTATION ARM THRU HUMERUS RE-AMPUTATION
|
Professional
|
Both
|
$2,445.00
|
|
|
Service Code
|
HCPCS 24930
|
| Min. Negotiated Rate |
$460.51 |
| Max. Negotiated Rate |
$1,833.75 |
| Rate for Payer: Aetna Commercial |
$946.33
|
| Rate for Payer: Aetna Medicare |
$734.47
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,016.96
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$946.33
|
| Rate for Payer: BCBS Complete |
$483.54
|
| Rate for Payer: BCBS MAPPO |
$706.22
|
| Rate for Payer: BCN Commercial |
$1,180.21
|
| Rate for Payer: BCN Medicare Advantage |
$706.22
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cash Price |
$1,956.00
|
| Rate for Payer: Cofinity Commercial |
$1,016.96
|
| Rate for Payer: Cofinity Commercial |
$946.33
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$706.22
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$741.53
|
| Rate for Payer: Meridian Medicaid |
$483.54
|
| Rate for Payer: Molina Medicare/Medicaid |
$776.84
|
| Rate for Payer: Nomi Health Commercial |
$847.46
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,833.75
|
| Rate for Payer: PACE SWMI |
$706.22
|
| Rate for Payer: PHP Commercial |
$988.71
|
| Rate for Payer: PHP Medicare Advantage |
$706.22
|
| Rate for Payer: Priority Health Choice Medicaid |
$460.51
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,261.61
|
| Rate for Payer: Priority Health Medicare |
$706.22
|
| Rate for Payer: Priority Health SBD |
$1,261.61
|
| Rate for Payer: Priority Health Tiered Network |
$1,261.61
|
| Rate for Payer: Railroad Medicare Medicare |
$706.22
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,353.91
|
| Rate for Payer: UHC Core |
$1,353.91
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$706.22
|
| Rate for Payer: UHC Exchange |
$1,353.91
|
| Rate for Payer: UHC Medicaid |
$460.51
|
| Rate for Payer: UHCCP Medicaid |
$460.51
|
| Rate for Payer: UMR Bronson Commercial |
$1,124.70
|
|
|
PR AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE
|
Professional
|
Both
|
$2,382.00
|
|
|
Service Code
|
HCPCS 24900
|
| Min. Negotiated Rate |
$459.23 |
| Max. Negotiated Rate |
$1,786.50 |
| Rate for Payer: Aetna Commercial |
$940.08
|
| Rate for Payer: Aetna Medicare |
$729.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,010.23
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$940.08
|
| Rate for Payer: BCBS Complete |
$482.19
|
| Rate for Payer: BCBS MAPPO |
$701.55
|
| Rate for Payer: BCN Commercial |
$1,167.26
|
| Rate for Payer: BCN Medicare Advantage |
$701.55
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cash Price |
$1,905.60
|
| Rate for Payer: Cofinity Commercial |
$1,010.23
|
| Rate for Payer: Cofinity Commercial |
$940.08
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$701.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$736.63
|
| Rate for Payer: Meridian Medicaid |
$482.19
|
| Rate for Payer: Molina Medicare/Medicaid |
$771.71
|
| Rate for Payer: Nomi Health Commercial |
$841.86
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,786.50
|
| Rate for Payer: PACE SWMI |
$701.55
|
| Rate for Payer: PHP Commercial |
$982.17
|
| Rate for Payer: PHP Medicare Advantage |
$701.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.23
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,247.77
|
| Rate for Payer: Priority Health Medicare |
$701.55
|
| Rate for Payer: Priority Health SBD |
$1,247.77
|
| Rate for Payer: Priority Health Tiered Network |
$1,247.77
|
| Rate for Payer: Railroad Medicare Medicare |
$701.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,288.64
|
| Rate for Payer: UHC Core |
$1,288.64
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$701.55
|
| Rate for Payer: UHC Exchange |
$1,288.64
|
| Rate for Payer: UHC Medicaid |
$459.23
|
| Rate for Payer: UHCCP Medicaid |
$459.23
|
| Rate for Payer: UMR Bronson Commercial |
$1,095.72
|
|
|
PR AMPUTATION FOOT MIDTARSAL
|
Professional
|
Both
|
$1,682.00
|
|
|
Service Code
|
HCPCS 28800
|
| Min. Negotiated Rate |
$313.32 |
| Max. Negotiated Rate |
$1,261.50 |
| Rate for Payer: Aetna Commercial |
$644.33
|
| Rate for Payer: Aetna Medicare |
$500.07
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$644.33
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$692.41
|
| Rate for Payer: BCBS Complete |
$328.99
|
| Rate for Payer: BCBS MAPPO |
$480.84
|
| Rate for Payer: BCN Commercial |
$796.27
|
| Rate for Payer: BCN Medicare Advantage |
$480.84
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Cash Price |
$1,345.60
|
| Rate for Payer: Cofinity Commercial |
$644.33
|
| Rate for Payer: Cofinity Commercial |
$692.41
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$480.84
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$504.88
|
| Rate for Payer: Meridian Medicaid |
$328.99
|
| Rate for Payer: Molina Medicare/Medicaid |
$528.92
|
| Rate for Payer: Nomi Health Commercial |
$577.01
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,261.50
|
| Rate for Payer: PACE SWMI |
$480.84
|
| Rate for Payer: PHP Commercial |
$673.18
|
| Rate for Payer: PHP Medicare Advantage |
$480.84
|
| Rate for Payer: Priority Health Choice Medicaid |
$313.32
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$851.19
|
| Rate for Payer: Priority Health Medicare |
$480.84
|
| Rate for Payer: Priority Health SBD |
$851.19
|
| Rate for Payer: Priority Health Tiered Network |
$851.19
|
| Rate for Payer: Railroad Medicare Medicare |
$480.84
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$938.83
|
| Rate for Payer: UHC Core |
$938.83
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$480.84
|
| Rate for Payer: UHC Exchange |
$938.83
|
| Rate for Payer: UHC Medicaid |
$313.32
|
| Rate for Payer: UHCCP Medicaid |
$313.32
|
| Rate for Payer: UMR Bronson Commercial |
$773.72
|
|
|
PR AMPUTATION FOOT TRANSMETARSAL
|
Professional
|
Both
|
$1,988.00
|
|
|
Service Code
|
HCPCS 28805
|
| Min. Negotiated Rate |
$414.07 |
| Max. Negotiated Rate |
$1,491.00 |
| Rate for Payer: Aetna Commercial |
$857.71
|
| Rate for Payer: Aetna Medicare |
$665.68
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$857.71
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$921.72
|
| Rate for Payer: BCBS Complete |
$434.77
|
| Rate for Payer: BCBS MAPPO |
$640.08
|
| Rate for Payer: BCN Commercial |
$1,059.70
|
| Rate for Payer: BCN Medicare Advantage |
$640.08
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cash Price |
$1,590.40
|
| Rate for Payer: Cofinity Commercial |
$857.71
|
| Rate for Payer: Cofinity Commercial |
$921.72
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$640.08
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$672.08
|
| Rate for Payer: Meridian Medicaid |
$434.77
|
| Rate for Payer: Molina Medicare/Medicaid |
$704.09
|
| Rate for Payer: Nomi Health Commercial |
$768.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,491.00
|
| Rate for Payer: PACE SWMI |
$640.08
|
| Rate for Payer: PHP Commercial |
$896.11
|
| Rate for Payer: PHP Medicare Advantage |
$640.08
|
| Rate for Payer: Priority Health Choice Medicaid |
$414.07
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,132.79
|
| Rate for Payer: Priority Health Medicare |
$640.08
|
| Rate for Payer: Priority Health SBD |
$1,132.79
|
| Rate for Payer: Priority Health Tiered Network |
$1,132.79
|
| Rate for Payer: Railroad Medicare Medicare |
$640.08
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,275.54
|
| Rate for Payer: UHC Core |
$1,275.54
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$640.08
|
| Rate for Payer: UHC Exchange |
$1,275.54
|
| Rate for Payer: UHC Medicaid |
$414.07
|
| Rate for Payer: UHCCP Medicaid |
$414.07
|
| Rate for Payer: UMR Bronson Commercial |
$914.48
|
|
|
PR AMPUTATION FOREARM THROUGH RADIUS & ULNA
|
Professional
|
Both
|
$2,452.00
|
|
|
Service Code
|
HCPCS 25900
|
| Min. Negotiated Rate |
$427.28 |
| Max. Negotiated Rate |
$1,839.00 |
| Rate for Payer: Aetna Commercial |
$874.38
|
| Rate for Payer: Aetna Medicare |
$678.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$874.38
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$939.63
|
| Rate for Payer: BCBS Complete |
$448.64
|
| Rate for Payer: BCBS MAPPO |
$652.52
|
| Rate for Payer: BCN Commercial |
$1,102.03
|
| Rate for Payer: BCN Medicare Advantage |
$652.52
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cash Price |
$1,961.60
|
| Rate for Payer: Cofinity Commercial |
$874.38
|
| Rate for Payer: Cofinity Commercial |
$939.63
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$652.52
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$685.15
|
| Rate for Payer: Meridian Medicaid |
$448.64
|
| Rate for Payer: Molina Medicare/Medicaid |
$717.77
|
| Rate for Payer: Nomi Health Commercial |
$783.02
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,839.00
|
| Rate for Payer: PACE SWMI |
$652.52
|
| Rate for Payer: PHP Commercial |
$913.53
|
| Rate for Payer: PHP Medicare Advantage |
$652.52
|
| Rate for Payer: Priority Health Choice Medicaid |
$427.28
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,178.04
|
| Rate for Payer: Priority Health Medicare |
$652.52
|
| Rate for Payer: Priority Health SBD |
$1,178.04
|
| Rate for Payer: Priority Health Tiered Network |
$1,178.04
|
| Rate for Payer: Railroad Medicare Medicare |
$652.52
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,240.15
|
| Rate for Payer: UHC Core |
$1,240.15
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$652.52
|
| Rate for Payer: UHC Exchange |
$1,240.15
|
| Rate for Payer: UHC Medicaid |
$427.28
|
| Rate for Payer: UHCCP Medicaid |
$427.28
|
| Rate for Payer: UMR Bronson Commercial |
$1,127.92
|
|
|
PR AMPUTATION LEG THROUGH TIBIA&FIBULA
|
Professional
|
Both
|
$2,791.00
|
|
|
Service Code
|
HCPCS 27880
|
| Min. Negotiated Rate |
$524.62 |
| Max. Negotiated Rate |
$2,093.25 |
| Rate for Payer: Aetna Commercial |
$1,100.31
|
| Rate for Payer: Aetna Medicare |
$853.98
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,100.31
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,182.43
|
| Rate for Payer: BCBS Complete |
$550.85
|
| Rate for Payer: BCBS MAPPO |
$821.13
|
| Rate for Payer: BCN Commercial |
$1,339.57
|
| Rate for Payer: BCN Medicare Advantage |
$821.13
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cash Price |
$2,232.80
|
| Rate for Payer: Cofinity Commercial |
$1,100.31
|
| Rate for Payer: Cofinity Commercial |
$1,182.43
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$821.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$862.19
|
| Rate for Payer: Meridian Medicaid |
$550.85
|
| Rate for Payer: Molina Medicare/Medicaid |
$903.24
|
| Rate for Payer: Nomi Health Commercial |
$985.36
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,093.25
|
| Rate for Payer: PACE SWMI |
$821.13
|
| Rate for Payer: PHP Commercial |
$1,149.58
|
| Rate for Payer: PHP Medicare Advantage |
$821.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$524.62
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,431.96
|
| Rate for Payer: Priority Health Medicare |
$821.13
|
| Rate for Payer: Priority Health SBD |
$1,431.96
|
| Rate for Payer: Priority Health Tiered Network |
$1,431.96
|
| Rate for Payer: Railroad Medicare Medicare |
$821.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,614.48
|
| Rate for Payer: UHC Core |
$1,614.48
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$821.13
|
| Rate for Payer: UHC Exchange |
$1,614.48
|
| Rate for Payer: UHC Medicaid |
$524.62
|
| Rate for Payer: UHCCP Medicaid |
$524.62
|
| Rate for Payer: UMR Bronson Commercial |
$1,283.86
|
|
|
PR AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR
|
Professional
|
Both
|
$2,204.00
|
|
|
Service Code
|
HCPCS 27882
|
| Min. Negotiated Rate |
$352.30 |
| Max. Negotiated Rate |
$1,653.00 |
| Rate for Payer: Aetna Commercial |
$736.08
|
| Rate for Payer: Aetna Medicare |
$571.28
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$736.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$791.01
|
| Rate for Payer: BCBS Complete |
$369.92
|
| Rate for Payer: BCBS MAPPO |
$549.31
|
| Rate for Payer: BCN Commercial |
$883.92
|
| Rate for Payer: BCN Medicare Advantage |
$549.31
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cash Price |
$1,763.20
|
| Rate for Payer: Cofinity Commercial |
$736.08
|
| Rate for Payer: Cofinity Commercial |
$791.01
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$549.31
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$576.78
|
| Rate for Payer: Meridian Medicaid |
$369.92
|
| Rate for Payer: Molina Medicare/Medicaid |
$604.24
|
| Rate for Payer: Nomi Health Commercial |
$659.17
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,653.00
|
| Rate for Payer: PACE SWMI |
$549.31
|
| Rate for Payer: PHP Commercial |
$769.03
|
| Rate for Payer: PHP Medicare Advantage |
$549.31
|
| Rate for Payer: Priority Health Choice Medicaid |
$352.30
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$944.88
|
| Rate for Payer: Priority Health Medicare |
$549.31
|
| Rate for Payer: Priority Health SBD |
$944.88
|
| Rate for Payer: Priority Health Tiered Network |
$944.88
|
| Rate for Payer: Railroad Medicare Medicare |
$549.31
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,058.88
|
| Rate for Payer: UHC Core |
$1,058.88
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$549.31
|
| Rate for Payer: UHC Exchange |
$1,058.88
|
| Rate for Payer: UHC Medicaid |
$352.30
|
| Rate for Payer: UHCCP Medicaid |
$352.30
|
| Rate for Payer: UMR Bronson Commercial |
$1,013.84
|
|
|
PR AMPUTATION METATARSAL W/TOE SINGLE
|
Professional
|
Both
|
$1,479.00
|
|
|
Service Code
|
HCPCS 28810
|
| Min. Negotiated Rate |
$253.04 |
| Max. Negotiated Rate |
$1,109.25 |
| Rate for Payer: Aetna Commercial |
$519.93
|
| Rate for Payer: Aetna Medicare |
$403.53
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$519.93
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$558.73
|
| Rate for Payer: BCBS Complete |
$265.69
|
| Rate for Payer: BCBS MAPPO |
$388.01
|
| Rate for Payer: BCN Commercial |
$636.42
|
| Rate for Payer: BCN Medicare Advantage |
$388.01
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cofinity Commercial |
$519.93
|
| Rate for Payer: Cofinity Commercial |
$558.73
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$388.01
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$407.41
|
| Rate for Payer: Meridian Medicaid |
$265.69
|
| Rate for Payer: Molina Medicare/Medicaid |
$426.81
|
| Rate for Payer: Nomi Health Commercial |
$465.61
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,109.25
|
| Rate for Payer: PACE SWMI |
$388.01
|
| Rate for Payer: PHP Commercial |
$543.21
|
| Rate for Payer: PHP Medicare Advantage |
$388.01
|
| Rate for Payer: Priority Health Choice Medicaid |
$253.04
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$680.32
|
| Rate for Payer: Priority Health Medicare |
$388.01
|
| Rate for Payer: Priority Health SBD |
$680.32
|
| Rate for Payer: Priority Health Tiered Network |
$680.32
|
| Rate for Payer: Railroad Medicare Medicare |
$388.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$751.89
|
| Rate for Payer: UHC Core |
$751.89
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$388.01
|
| Rate for Payer: UHC Exchange |
$751.89
|
| Rate for Payer: UHC Medicaid |
$253.04
|
| Rate for Payer: UHCCP Medicaid |
$253.04
|
| Rate for Payer: UMR Bronson Commercial |
$680.34
|
|
|
PR AMPUTATION PENIS COMPLETE
|
Professional
|
Both
|
$1,599.00
|
|
|
Service Code
|
HCPCS 54125
|
| Min. Negotiated Rate |
$476.48 |
| Max. Negotiated Rate |
$1,438.84 |
| Rate for Payer: Aetna Commercial |
$988.36
|
| Rate for Payer: Aetna Medicare |
$767.08
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,062.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$988.36
|
| Rate for Payer: BCBS Complete |
$500.30
|
| Rate for Payer: BCBS MAPPO |
$737.58
|
| Rate for Payer: BCN Commercial |
$1,239.97
|
| Rate for Payer: BCN Medicare Advantage |
$737.58
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cash Price |
$1,279.20
|
| Rate for Payer: Cofinity Commercial |
$1,062.12
|
| Rate for Payer: Cofinity Commercial |
$988.36
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$737.58
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$774.46
|
| Rate for Payer: Meridian Medicaid |
$500.30
|
| Rate for Payer: Molina Medicare/Medicaid |
$811.34
|
| Rate for Payer: Nomi Health Commercial |
$885.10
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,199.25
|
| Rate for Payer: PACE SWMI |
$737.58
|
| Rate for Payer: PHP Commercial |
$1,032.61
|
| Rate for Payer: PHP Medicare Advantage |
$737.58
|
| Rate for Payer: Priority Health Choice Medicaid |
$476.48
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,350.74
|
| Rate for Payer: Priority Health Medicare |
$737.58
|
| Rate for Payer: Priority Health SBD |
$1,350.74
|
| Rate for Payer: Priority Health Tiered Network |
$1,350.74
|
| Rate for Payer: Railroad Medicare Medicare |
$737.58
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,438.84
|
| Rate for Payer: UHC Core |
$1,438.84
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$737.58
|
| Rate for Payer: UHC Exchange |
$1,438.84
|
| Rate for Payer: UHC Medicaid |
$476.48
|
| Rate for Payer: UHCCP Medicaid |
$476.48
|
| Rate for Payer: UMR Bronson Commercial |
$735.54
|
|
|
PR AMPUTATION PENIS PARTIAL
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
HCPCS 54120
|
| Min. Negotiated Rate |
$367.64 |
| Max. Negotiated Rate |
$1,112.94 |
| Rate for Payer: Aetna Commercial |
$760.52
|
| Rate for Payer: Aetna Medicare |
$590.25
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$760.52
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$817.27
|
| Rate for Payer: BCBS Complete |
$386.02
|
| Rate for Payer: BCBS MAPPO |
$567.55
|
| Rate for Payer: BCN Commercial |
$950.64
|
| Rate for Payer: BCN Medicare Advantage |
$567.55
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cash Price |
$990.40
|
| Rate for Payer: Cofinity Commercial |
$760.52
|
| Rate for Payer: Cofinity Commercial |
$817.27
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$567.55
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$595.93
|
| Rate for Payer: Meridian Medicaid |
$386.02
|
| Rate for Payer: Molina Medicare/Medicaid |
$624.30
|
| Rate for Payer: Nomi Health Commercial |
$681.06
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$928.50
|
| Rate for Payer: PACE SWMI |
$567.55
|
| Rate for Payer: PHP Commercial |
$794.57
|
| Rate for Payer: PHP Medicare Advantage |
$567.55
|
| Rate for Payer: Priority Health Choice Medicaid |
$367.64
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,035.55
|
| Rate for Payer: Priority Health Medicare |
$567.55
|
| Rate for Payer: Priority Health SBD |
$1,035.55
|
| Rate for Payer: Priority Health Tiered Network |
$1,035.55
|
| Rate for Payer: Railroad Medicare Medicare |
$567.55
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,112.94
|
| Rate for Payer: UHC Core |
$1,112.94
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$567.55
|
| Rate for Payer: UHC Exchange |
$1,112.94
|
| Rate for Payer: UHC Medicaid |
$367.64
|
| Rate for Payer: UHCCP Medicaid |
$367.64
|
| Rate for Payer: UMR Bronson Commercial |
$569.48
|
|
|
PR AMPUTATION PENIS RADW/BI INGUINOFEMORAL LMPHADE
|
Professional
|
Both
|
$2,556.00
|
|
|
Service Code
|
HCPCS 54130
|
| Min. Negotiated Rate |
$681.39 |
| Max. Negotiated Rate |
$2,109.77 |
| Rate for Payer: Aetna Commercial |
$1,416.61
|
| Rate for Payer: Aetna Medicare |
$1,099.46
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,416.61
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,522.32
|
| Rate for Payer: BCBS Complete |
$715.46
|
| Rate for Payer: BCBS MAPPO |
$1,057.17
|
| Rate for Payer: BCN Commercial |
$1,779.78
|
| Rate for Payer: BCN Medicare Advantage |
$1,057.17
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cash Price |
$2,044.80
|
| Rate for Payer: Cofinity Commercial |
$1,416.61
|
| Rate for Payer: Cofinity Commercial |
$1,522.32
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$1,057.17
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$1,110.03
|
| Rate for Payer: Meridian Medicaid |
$715.46
|
| Rate for Payer: Molina Medicare/Medicaid |
$1,162.89
|
| Rate for Payer: Nomi Health Commercial |
$1,268.60
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,917.00
|
| Rate for Payer: PACE SWMI |
$1,057.17
|
| Rate for Payer: PHP Commercial |
$1,480.04
|
| Rate for Payer: PHP Medicare Advantage |
$1,057.17
|
| Rate for Payer: Priority Health Choice Medicaid |
$681.39
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,938.76
|
| Rate for Payer: Priority Health Medicare |
$1,057.17
|
| Rate for Payer: Priority Health SBD |
$1,938.76
|
| Rate for Payer: Priority Health Tiered Network |
$1,938.76
|
| Rate for Payer: Railroad Medicare Medicare |
$1,057.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$2,109.77
|
| Rate for Payer: UHC Core |
$2,109.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$1,057.17
|
| Rate for Payer: UHC Exchange |
$2,109.77
|
| Rate for Payer: UHC Medicaid |
$681.39
|
| Rate for Payer: UHCCP Medicaid |
$681.39
|
| Rate for Payer: UMR Bronson Commercial |
$1,175.76
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR ANY LEVEL
|
Professional
|
Both
|
$2,659.00
|
|
|
Service Code
|
HCPCS 27590
|
| Min. Negotiated Rate |
$459.87 |
| Max. Negotiated Rate |
$1,994.25 |
| Rate for Payer: Aetna Commercial |
$964.97
|
| Rate for Payer: Aetna Medicare |
$748.94
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1,036.99
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$964.97
|
| Rate for Payer: BCBS Complete |
$482.86
|
| Rate for Payer: BCBS MAPPO |
$720.13
|
| Rate for Payer: BCN Commercial |
$1,167.26
|
| Rate for Payer: BCN Medicare Advantage |
$720.13
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cash Price |
$2,127.20
|
| Rate for Payer: Cofinity Commercial |
$1,036.99
|
| Rate for Payer: Cofinity Commercial |
$964.97
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$720.13
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$756.14
|
| Rate for Payer: Meridian Medicaid |
$482.86
|
| Rate for Payer: Molina Medicare/Medicaid |
$792.14
|
| Rate for Payer: Nomi Health Commercial |
$864.16
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,994.25
|
| Rate for Payer: PACE SWMI |
$720.13
|
| Rate for Payer: PHP Commercial |
$1,008.18
|
| Rate for Payer: PHP Medicare Advantage |
$720.13
|
| Rate for Payer: Priority Health Choice Medicaid |
$459.87
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,247.77
|
| Rate for Payer: Priority Health Medicare |
$720.13
|
| Rate for Payer: Priority Health SBD |
$1,247.77
|
| Rate for Payer: Priority Health Tiered Network |
$1,247.77
|
| Rate for Payer: Railroad Medicare Medicare |
$720.13
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,410.93
|
| Rate for Payer: UHC Core |
$1,410.93
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$720.13
|
| Rate for Payer: UHC Exchange |
$1,410.93
|
| Rate for Payer: UHC Medicaid |
$459.87
|
| Rate for Payer: UHCCP Medicaid |
$459.87
|
| Rate for Payer: UMR Bronson Commercial |
$1,223.14
|
|
|
PR AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION
|
Professional
|
Both
|
$2,501.00
|
|
|
Service Code
|
HCPCS 27596
|
| Min. Negotiated Rate |
$420.89 |
| Max. Negotiated Rate |
$1,875.75 |
| Rate for Payer: Aetna Commercial |
$875.85
|
| Rate for Payer: Aetna Medicare |
$679.76
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$875.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$941.21
|
| Rate for Payer: BCBS Complete |
$441.93
|
| Rate for Payer: BCBS MAPPO |
$653.62
|
| Rate for Payer: BCN Commercial |
$1,066.18
|
| Rate for Payer: BCN Medicare Advantage |
$653.62
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cash Price |
$2,000.80
|
| Rate for Payer: Cofinity Commercial |
$875.85
|
| Rate for Payer: Cofinity Commercial |
$941.21
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$653.62
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$686.30
|
| Rate for Payer: Meridian Medicaid |
$441.93
|
| Rate for Payer: Molina Medicare/Medicaid |
$718.98
|
| Rate for Payer: Nomi Health Commercial |
$784.34
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$1,875.75
|
| Rate for Payer: PACE SWMI |
$653.62
|
| Rate for Payer: PHP Commercial |
$915.07
|
| Rate for Payer: PHP Medicare Advantage |
$653.62
|
| Rate for Payer: Priority Health Choice Medicaid |
$420.89
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,139.72
|
| Rate for Payer: Priority Health Medicare |
$653.62
|
| Rate for Payer: Priority Health SBD |
$1,139.72
|
| Rate for Payer: Priority Health Tiered Network |
$1,139.72
|
| Rate for Payer: Railroad Medicare Medicare |
$653.62
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,262.53
|
| Rate for Payer: UHC Core |
$1,262.53
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$653.62
|
| Rate for Payer: UHC Exchange |
$1,262.53
|
| Rate for Payer: UHC Medicaid |
$420.89
|
| Rate for Payer: UHCCP Medicaid |
$420.89
|
| Rate for Payer: UMR Bronson Commercial |
$1,150.46
|
|
|
PR AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR
|
Professional
|
Both
|
$3,190.00
|
|
|
Service Code
|
HCPCS 27592
|
| Min. Negotiated Rate |
$400.65 |
| Max. Negotiated Rate |
$2,392.50 |
| Rate for Payer: Aetna Commercial |
$835.57
|
| Rate for Payer: Aetna Medicare |
$648.50
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$835.57
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$897.93
|
| Rate for Payer: BCBS Complete |
$420.68
|
| Rate for Payer: BCBS MAPPO |
$623.56
|
| Rate for Payer: BCN Commercial |
$1,011.40
|
| Rate for Payer: BCN Medicare Advantage |
$623.56
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cash Price |
$2,552.00
|
| Rate for Payer: Cofinity Commercial |
$835.57
|
| Rate for Payer: Cofinity Commercial |
$897.93
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$623.56
|
| Rate for Payer: Meridian Complete - MI Health Link - DSNP/Wellcare - Medicare Advantage |
$654.74
|
| Rate for Payer: Meridian Medicaid |
$420.68
|
| Rate for Payer: Molina Medicare/Medicaid |
$685.92
|
| Rate for Payer: Nomi Health Commercial |
$748.27
|
| Rate for Payer: Opus (Opus Packaging Group) HMA |
$2,392.50
|
| Rate for Payer: PACE SWMI |
$623.56
|
| Rate for Payer: PHP Commercial |
$872.98
|
| Rate for Payer: PHP Medicare Advantage |
$623.56
|
| Rate for Payer: Priority Health Choice Medicaid |
$400.65
|
| Rate for Payer: Priority Health Cigna Priority Health/HMO/PPO/Narrow Network |
$1,081.16
|
| Rate for Payer: Priority Health Medicare |
$623.56
|
| Rate for Payer: Priority Health SBD |
$1,081.16
|
| Rate for Payer: Priority Health Tiered Network |
$1,081.16
|
| Rate for Payer: Railroad Medicare Medicare |
$623.56
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$1,196.77
|
| Rate for Payer: UHC Core |
$1,196.77
|
| Rate for Payer: UHC Dual Complete DSNP/Medicare Advantage |
$623.56
|
| Rate for Payer: UHC Exchange |
$1,196.77
|
| Rate for Payer: UHC Medicaid |
$400.65
|
| Rate for Payer: UHCCP Medicaid |
$400.65
|
| Rate for Payer: UMR Bronson Commercial |
$1,467.40
|
|
